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Effects of Conservative Interventions on Static and Dynamic Balance in Individuals with Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Published:November 20, 2022DOI:https://doi.org/10.1016/j.apmr.2022.10.014

      Abstract

      Objective

      : To determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI).

      Data sources

      PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022.

      Study selection

      Randomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared to those of different conservative interventions or controls were included.

      Data extraction

      Two independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach.

      Data synthesis

      Forty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval (CI), 0.58–1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24–0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41–1.14; and 0.75; CI, 0.35–1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared to that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32–1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08–1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence).

      Conclusions

      : The significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.

      Keywords

      List of abbreviations:

      CAI (chronic ankle instability), WBVT (whole-body vibration training), BT (balance training), SMD (standardized mean differences), ST (strength training), LAS (lateral ankle sprain), RCT (randomized control trial), SEBT (Star Excursion Balance Test), TDCS (transcranial direct current stimulation), CI (confidence interval), COP (center of pressure)
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